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MSM with HIV experience high rates of asymptomatic chlamydia, gonorrhea
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SAN DIEGO — Rates of asymptomatic chlamydia and gonorrhea are high among HIV-infected men who have sex with men, according to data presented here.
Additionally, both extragenital and urine screening may be necessary to detect asymptomatic cases of these STDs, according to Uriel Sandkovsky, MD, FACP, of the infectious disease division at the University of Nebraska Medical Center, Omaha.
Uriel Sandkovsky
“STDs are very common in the MSM population,” Sandkovsky said during a presentation. “Our rates were dramatically higher among HIV-infected MSM, and most infections were asymptomatic. This underscores the need to perform routine screening in high-risk groups.”
Sandkovsky and colleagues examined a sample of MSM with HIV aged older than 19 years at their hospital who did not demonstrate symptoms of STD infection and did not receive chlamydia or gonorrhea treatment within the previous 3 weeks. Urine, rectum and oropharynx screenings for the two STDs were conducted during regular clinic visits. Samples were analyzed using nucleic acid amplification tests, and participants were surveyed about sexual behavior, substance abuse and risk factors, the results from which were analyzed alongside other collected demographic and clinical data.
There were 149 participants for whom urine, rectal and oropharynx samples were available. More than half of the patients were white, with a mean age of 40.9 years. Positive chlamydia or gonorrhea tests from at least one site were collected from 18 patients. Among these, 14 had extragenital infections, two were diagnosed only through urine analysis and two tested positively in all three diagnostic sites.
Those who reported receiving anal sex in the previous year or the use of cocaine or methamphetamine drugs within 6 months were more likely to receive a positive diagnosis. Overall rates of chlamydia and gonorrhea infection among participants were 18 and 17 times greater than those detected through public health screening of the surrounding community in Omaha. When testing all three sites, the combined incidence rate of chlamydia and gonorrhea was 12.1%, while the incidence rates were 11% and 3%, respectively, after testing extragenital sites and urine analysis. Three-quarters of chlamydia and 100% of gonorrhea infections would have been missed if these patients had received urine screening alone, according to the researchers, highlighting the need for additional testing among this population.
“The chance of finding either gonorrhea or chlamydia will increase substantially if you add extragenital sites to the testing,” Sandkovsky said. “Urine sample is very convenient. You give a cup to the patient, the patient will return the cup and that’s it, but you will miss a large number of infections, and this is something that we have to try to tackle more efficiently.” – by Dave Muoio
Reference:
Sandkovsky U, et al. Abstract 120. Presented at: IDWeek; Oct. 7-11, 2015; San Diego.
Disclosure: Sandkovsky reports no relevant financial disclosures.
Perspective
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Paul A. Volberding, MD
We’ve grown used to the fact that we’re seeing an increase in syphilis and gonorrhea in different populations that are affected by HIV. We’ve observed in San Francisco is — especially as we’ve been doing more systematic screening for chlamydia — that there’s also a very solid increase in infection. What we’ve noticed and what’s been reported at this meeting is that a lot of these cases are asymptomatic, but they also involve extragenital sites — either the oral cavity or the rectum — and you’re not going to find it if you’re not screening there. We should really be thinking about our screening strategies.
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